[Dermatological manifestations of COVID-19]. / Les manifestations dermatologiques de la COVID-19.

Besides the principal respiratory symptoms, the COVID-19 has been associated with an important array of dermatological manifestations. However, it is not always easy to distinguish whether these skin manifestations are the result of a direct action of the virus on epidermal and/or dermal cell populations, represent a paraviral phenomenon or are a rather fortuitous association. In this review the principal cutaneous manifestations associated with COVID-19 are described as well as their eventual value in terms of diagnostic aid or as prognostic factor. The palmoplantar ischemic pseudo-chilblains lesions are the most frequently observed and are useful for epidemiological purposes. The disseminated vesicular eruptions affect about 23 % of the patient and may witness an initial COVID-19 infection, whereas the vasculitic lesions are rather rare but are currently considered as a factor of bad prognosis.

Outre les symptômes principaux respiratoires, la COVID-19 a été associée avec toute une série de manifestations cutanées. Néanmoins, dans de nombreuses publications, il est assez difficile de discerner si la COVID-19 est directement causale des lésions cutanées, s'il s'agit plutôt d'un phénomène cutané paraviral ou si l'association est fortuite. Dans cette revue, les manifestations cutanées associées à la COVID-19 sont décrites ainsi que leur éventuelle valeur diagnostique et/ou pronostique. Les lésions de type acral (pseudo-engelure) sont les plus fréquentes et surtout utiles pour des données épidémiologiques. Les éruptions vésiculeuses disséminées touchent environ 23 % des patients et peuvent suggérer une infection récente par la COVID-19. Les lésions de type vasculite sont plutôt rares, mais peuvent être considérées comme un facteur de mauvais pronostic.

[Severe crusted scabies: A "historic" case involving the death of a 52-year-old patient]. / Gale hyperkératosique sévère : atteinte « historique ¼ et décès d'une patiente de 52ans.

BACKGROUND: Crusted scabies, also known as Norwegian scabies, is a rare and extremely debilitating form of Sarcoptes scabiei var. hominis infestation that generally occurs in immunosuppressed patients. Herein, we report a "historic" and fatal case. PATIENTS AND METHODS: A 52-year-old woman was admitted to the emergency department presenting crusted dermatitis together with extreme deterioration of her general condition. Her general practitioner had initiated dermo-corticosteroid therapy for suspected atopic dermatitis two months earlier, and she had been confined to bed for the previous 10 days. Her son presented pruritus that became worse at night. On examination the patient was moaning, dehydrated and confused and her entire skin was hyperkeratotic, with very thick, yellowish, cracked crusts covering 40 % of her body. Tests indicated severe water and electrolytic disorders as well as Staphylococcus aureus bacteremia. A tape test established the diagnosis of crusted scabies. The severity was grade III on the Davis clinical grading scale. The patient showed signs of multi-organ failure and was transferred to intensive care, but she died during the night. DISCUSSION: This case is remarkable for its historic severity. In France, scabies infestation is a re-emerging disease and has been a public health priority since 2012. The rare hyperkeratotic form is not fully understood and frequently diagnosed late, in some cases with a fatal outcome.

[Crusted scabies: A review]. / La gale hyperkératosique.

Crusted scabies is a rare and severe form of infestation by Sarcoptes scabies var. hominis. It is characterized by profuse hyperkeratosis containing over 4000 mites per gram of skin, with treatment being long and difficult. The condition is both direct and indirectly contagious. It has a central role in epidemic cycles of scabies, the incidence of which is on the rise in economically stable countries. Recent discoveries concerning the biology of mites, the pathophysiology of hyperkeratosis and the key role of IL-17 in this severe form open up new therapeutic perspectives.

Hemodynamic effects of a new antiarrhythmic agent: cibenzoline.

The hemodynamic effects of an intravenous dose of 1 mg/kg of Cibenzoline, a new anti-arrhythmic agent with properties of classes I, III and IV of the Vaughan-Williams classification, were studied in 9 patients during routine cardiac catheterization. Six patients had valvular heart disease (aortic insufficiency in 5 and mitral stenosis in 1), one patient had ischemic heart disease, one patient had alcoholic cardiomyopathy and the remaining patient had coarctation of the thoracic aorta. Left ventricular pressure and right sided intracardiac pressures were recorded using a high fidelity transduced and a Swan-Ganz catheter respectively. The first derivative of the left ventricular pressure was obtained electronically and Vmax calculated by linear extrapolation to zero load of the contractile element shortening velocity--left ventricular pressure relationship. Plasma levels of Cibenzoline were measured by gas liquid chromatography. All these parameters were obtained under baseline conditions and then 5, 10, 20, 40 and 60 minutes after intravenous administration of Cibenzoline. Cardiac index fell by 20% 5 minutes after the injection of Cibenzoline, and returned to control after one hour only. This fall was primarily related to a decrease in stroke index, since heart rate remained virtually unchanged. Right and left ventricular filling pressures increased significantly from the 5th to the 40th minute. Aortic systolic pressure fell by approximately 6%, without any change in mean and diastolic aortic pressures. Peripheral and pulmonary resistances increased at 20 minutes by 33% and 45%, respectively. Left ventricular peak positive dP/dt and Vmax decreased significantly at 5 minutes and remained below the baseline value until 60 minutes by 9% and 11% respectively. Percent changes in cardiac index, dP/dt and Vmax were significantly correlated to cibenzoline plasma levels (r = 0.85, 0.79, 0.74 respectively; n = 45). Thus, doses achieving plasma levels within the reported therapeutic range (250-350 ng/ml) would be expected to result in a 8-12% decrease in cardiac output associated with 12-17% and 15-21% reduction of left ventricular dP/dt and Vmax respectively. These data indicate that cibenzoline exerts significant negative inotropic effects. Its use in the subset of patients with severely depressed ventricular function warrants caution.

[Hemodynamic effects of sublingual molsidomine in patients with or without cardiac failure]. / Effets hémodynamiques de la molsidomine par voie sublinguale chez des patients avec et sans insuffisance cardiaque.

A haemodynamic study was performed in 12 men aged between 28 and 64 years, including 8 with clinical signs of congestive cardiac failure and an ejection fraction of less than 50 per cent. The pulmonary artery pressure, capillary pressure, left ventricular pressure, cardiac output and the arterial and venous oxygen tensions were measured before (T 0) and after sublingual administration of 4 mg of molsidomine (T 15, T 30, T 45, T 60 min) and 3 minutes after a dose of 0.6 mg sublingual trinitrine (given immediately after the measurements made at T 60). The haemodynamic modifications were very significant at the 30th minute and reached a plateau between the 45th and 60th minute. The left and right ventricular filling pressures fell by more than 25 per cent, the aortic pressure fell by 17 per cent. There was a mild decrease (8 per cent) in the cardiac index and the systolic index, without any significant change in the heart rate. The reduction in the cardiac index and the systolic index was not significant in patients with cardiac failure and an ejection fraction of less than 50 per cent. The peripheral vascular resistance fell by 9 per cent. Finally, there was a significant reduction in the cardiac work and power and especially in the pressure-time index per beat and per minute. The administration of 0.6 mg of sublingual trinitrine induced an additional reduction in the aortic pressure with acceleration of the heart rate and a slight increase in the cardiac output, but no additional venodilator effect was detected.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bacterial endocarditis and echocardiography]. / L'endocardite bactérienne et l'échocardiographie.

The authors present a case of enterococcal bacterial endocarditis in which a high degree of correlation was found between the echocardiographic findings and the anatomical lesions found at autopsy. They review the value of echocardiography as a simple non-invasive technique in the diagnosis and assessment of bacterial endocarditis.